NEW YORK (Reuters Health) May 04 - In certain patients with locally advanced cervical cancer, exenteration is an effective primary treatment, German researchers report in an April 7th online paper in the American Journal of Obstetrics and Gynecology.
"Exenteration can be an alternative to radiotherapy in cases of advanced cervical carcinoma. Especially when the tumor has not yet spread to the local lymph nodes, long term results are very good and patients should be offered this alternative therapy," Dr. Dirk Michael Forner told Reuters Health by email.
Dr. Forner and Dr. Bjoern Lampe of Florence Nightingale Hospital, Dusseldorf, note that although exenteration is an established approach in recurrent cervical carcinoma, it's not often performed for primary locally advanced cervical cancer.
Opinions are divided on its value, and they point out that a recent study showed that about half of surveyed German physicians would consider such use -- far more than was true of their US counterparts.
To gain more information, the team retrospectively studied data on all 35 patients who underwent a pelvic exenteration for primary cervical cancer at their institution over a period of 10 years. All operations were performed by the authors.
In 20 patients, pelvic lymph nodes were involved, and in six of these, metastatic tissue had reached the para-aortal nodes. Patients with positive lymph nodes received adjuvant radiochemotherapy.
After surgery, 34 patients (97%) were macroscopically free of tumor. This was confirmed microscopically in 30 patients (86%).
After a median follow-up of more than 5 years, median disease-free survival was 21 months and overall survival was 30 months. The probability of 5-year survival was 43%.
Median survival was greater in patients who underwent complete resection compared to those who did not (47% versus less than 10%).
Prognosis was also significantly better in patients with negative lymph nodes. Median overall survival was 44 months compared to 15 months in positive patients. Their probability of 5-year survival was 70% compared to 15%.
Pelvic lymph node involvement, the researchers observe, was the only factor significantly affecting overall survival.
"Pelvic exenteration is a treatment option that shows good long-term results and an acceptable perioperative risk," they conclude.
"When the tumor can be fully resected and there is no spread to lymph nodes or distant metastases," the investigators add, the results "are at least equivalent to those of chemoradiation."
"Exenteration can be an alternative to radiotherapy in cases of advanced cervical carcinoma. Especially when the tumor has not yet spread to the local lymph nodes, long term results are very good and patients should be offered this alternative therapy," Dr. Dirk Michael Forner told Reuters Health by email.
Dr. Forner and Dr. Bjoern Lampe of Florence Nightingale Hospital, Dusseldorf, note that although exenteration is an established approach in recurrent cervical carcinoma, it's not often performed for primary locally advanced cervical cancer.
Opinions are divided on its value, and they point out that a recent study showed that about half of surveyed German physicians would consider such use -- far more than was true of their US counterparts.
To gain more information, the team retrospectively studied data on all 35 patients who underwent a pelvic exenteration for primary cervical cancer at their institution over a period of 10 years. All operations were performed by the authors.
In 20 patients, pelvic lymph nodes were involved, and in six of these, metastatic tissue had reached the para-aortal nodes. Patients with positive lymph nodes received adjuvant radiochemotherapy.
After surgery, 34 patients (97%) were macroscopically free of tumor. This was confirmed microscopically in 30 patients (86%).
After a median follow-up of more than 5 years, median disease-free survival was 21 months and overall survival was 30 months. The probability of 5-year survival was 43%.
Median survival was greater in patients who underwent complete resection compared to those who did not (47% versus less than 10%).
Prognosis was also significantly better in patients with negative lymph nodes. Median overall survival was 44 months compared to 15 months in positive patients. Their probability of 5-year survival was 70% compared to 15%.
Pelvic lymph node involvement, the researchers observe, was the only factor significantly affecting overall survival.
"Pelvic exenteration is a treatment option that shows good long-term results and an acceptable perioperative risk," they conclude.
"When the tumor can be fully resected and there is no spread to lymph nodes or distant metastases," the investigators add, the results "are at least equivalent to those of chemoradiation."
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